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I represent a former advertising executive whose long term disability (“LTD”) benefits were terminated by Unum after its in house psychiatrist rejected the opinion of the claimant’s treating psychologist. Unum had repeatedly approved LTD benefits based upon the treating psychologoist’s summary narrative reports and responses to Unum’s form questionnaires. Unum terminated benefits after its psychiatrist issued a medical report that concluded the claimant was no longer disabled.
The report from Unum’s psychiatrist set forth eight reasons why the claimant was not disabled. Fortunately, the treating psychologist continued to support the claimant’s inability to work, and provided a detailed report that rebutted each of the eight reasons espoused by Unum’s psychiatrist. Without being able to rely on the report of its psychiatrist any longer, Unum reinstated the claimant’s LTD benefits.
LTD insurance companies always defer to their doctors’ opinions. Therefore, in order to succeed in reversing an adverse determination, you need to ensure that the treating doctors specifically address and rebut each of the contentions that the insurer relied on to rationalize its denial or termination.Previous Next
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